A prospective study of the changes in thyrotropin binding inhibitory immunoglobulins in Graves' disease treated by subtotal thyroidectomy or radioactive iodine.

The effects of subtotal thyroidectomy and radioactive iodine on thyroid-stimulating immunoglobulins, as measured by a receptor assay, more appropriately termed TSH binding inhibitory immunoglobulins (TBII), were studied in 74 patients with Graves' disease. Fourty-four patients received radioactive iodine therapy, while 30 were subjected to subtotal thyroidectomy. After radioactive iodine, more patients were TBII-positive (90.5% vs. 81.8%) than before treatment, and the mean TBII index decreased dramatically, the maximum decrease being at 3 months. The mean TBII index subsequently returned gradually to the pretreatment level. Subtotal thyroidectomy had a different effect on TBII activity. TBII indices were positive in 89.3% of these patients before any treatment but were positive in only 40% (12 patients) after antithyroid drugs had been given before surgery. After surgery, TBII indices remained positive in 7 patients, while the remaining 5 patients became TBII negative. Seventeen patients (56.7%) were TBII negative before operation and remained so after surgery. One patient who was TBII negative before operation became TBII positive 2 months after operation. Interestingly, postoperative relapse of hyperthyroidism occurred in 3 patients who were TBII positive, while hypothyroidism occurred in 7 patients who were TBII negative. Thus, the TBII activity after subtotal thyroidectomy might be an important factor in determining the outcome of surgery.

Cysticercosis of the breast.

A painless lump in the breast in a 43-year-old Chinese woman was found on surgical excision to be a cysticercus presumed to be that of Taenia solium. Routine investigations failed to reveal infection at any other site.

Idiopathic gynecomastia treated with tamoxifen: a preliminary report.

Sixty-one Chinese men with idiopathic gynecomastia were treated with 40 mg of tamoxifen daily for one of four months (median, two months). Eighty percent had complete regression of their breast swelling. No long-term side effects of tamoxifen were observed over a median follow-up period of 36 months.

Fibromatosis of the breast: case report and review of the literature.

A case of fibromatosis arising in the breast of a 20-yr-old Chinese female is described. Fibromatosis of the breast is rare. There are only 19 reported cases in the literature, including 5 in which exclusion of musculoaponeurotic origin is impossible because of pectoral muscle involvement. Fibromatosis is a locally infiltrative growth and clinically may mimic a breast carcinoma. Wide local excision is the treatment of choice. Radical mastectomy was performed in 3 previously reported cases because of erroneous clinical diagnoses.

Benign spindle cell tumour of breast--a variant of spindled cell lipoma or fibroma of breast?

A case of the so-called "benign spindle cell tumour of breast" is presented. Ultrastructurally, it is composed of fibroblastic cells cut in various planes. We believe that it is basically a fibroma. Its relationship to spindle cell lipoma is discussed.

Current status of breast cancer in Hong Kong.

OBJECTIVE: To study the mode of presentation, the tumor, nodes, metastasis (TNM) staging and the efficacy of multimodal treatment of breast cancer among Chinese women treated in Queen Mary Hospital. METHODS: The available records of all breast cancer patients treated between January 1980 and December 1994 were reviewed. The mode of presentation, the TNM staging of the disease, estrogen receptor status and the mode of surgical and adjuvant treatment were studied. Statistical correlation was performed between the factors studied and the survival time. RESULTS: Seven hundred and one cases of breast cancer were identified. The mean age of the patients was 56.6 years (range, 20-98 years). The most common complaint was the presence of a mass which occurred in 635 (90.6%) patients and 454 (71.5%) of these patients were painless. The majority of patients had T2 tumours (51.8%) and stage II disease (59.6%), but only 86 (12.3%) patients underwent breast conservative therapy (BCT). Estrogen receptor was positive in 43% of patients. Two hundred and ninety (41.4%) patients were node positive and the mean number of involved nodes was 3.8 per patient. Adjuvant chemotherapy was given to 125 node positive patients, adjuvant tamoxifen to 188 patients and both to 63 patients. Univariate analyses of factors possibly affecting survival showed that advanced stage disease and nodal involvement were associated with a significantly lower survival time. Among the node positive patients, those with seven or more involved nodes had a shorter survival. The types of surgery and adjuvant treatment (for node positive patients) had no direct correlation with survival. CONCLUSION: Our results showed that the majority of our patients presented with a painless mass and the final outcome was determined by the tumour load at the time of presentation (TNM staging and nodal status).

Uncommon forms of mastitis.

Three different types of chronic mastitis were seen in a review of cases over a twenty-five-year-period. These were tuberculous mastitis, non-specific granulomatous mastitis, and oleogranulomatous mastitis. Their common modes of presentation and some of the difficulties encountered in diagnosing these lesions are discussed.

Tamoxifen versus chemotherapy as adjuvant treatment in stage III breast cancer.

A randomized prospective trial was conducted to compare Tamoxifen and combination chemotherapy (5-fluorouracil, doxorubicin and cyclophosphamide) as adjuvant treatment for patients with locally advanced (Stage III) breast cancer. At the end of 5 years, no significant difference could be found in the disease-free period for both groups.

No decrease in duodenal ulcer surgery after cimetidine in Hong Kong.

We undertook a 12-year review of the elective and emergency surgery for duodenal ulcer in Queen Mary Hospital, Hong Kong, to ascertain whether the introduction of cimetidine as treatment for duodenal ulcer had led to a reduction in the number of elective and emergency operations being performed for duodenal ulcer. There was no decrease in the number of elective operations performed for duodenal ulcer. Indeed, in the same period, emergency operations for bleeding and perforated ulcers had increased.

Benign breast disorders in nonwestern populations: Part I--Benign breast disorders in Chinese women.

Experience with benign breast disorders has been analyzed in 3 nonwestern populations: Hong Kong, India, and Northern Nigeria. Similarities to and differences from Western experience are found, but of great interest are notable differences between these populations which, as yet, lack explanation. All show "fibroadenosis" and fibroadenoma as common conditions, but the frequency with which phyllodes tumor is diagnosed varies between different centers in India as well as between different racial groups. Tuberculosis is another interesting example--wide differences in the frequency of breast infection are found although tuberculosis itself is common in all 3 countries. The value of prospective studies was shown when mastalgia was studied in this way in India. Often considered a "Western" affliction, these authors have been able to study 112 cases of mastalgia and found it to be twice as common as cancer as a presentation. These differing experiences between populations have been little explored and must hold promise for unravelling some of the enigmas of benign breast disorders in all countries.

Limitations of mammography in Chinese females.

The usefulness of mammography was evaluated in 50 Chinese female patients with breast disease. There was only 12% accuracy in the diagnosis of benign breast disease and an overall accuracy of 32% for all breast lesions. This low diagnostic rate is due to the difficulty in visualising mammographic detail in the small Chinese breast.

Psychosocial effects of mastectomy: is it due to mastectomy or to the diagnosis of malignancy?

Twenty-three consecutive married and sexually active Chinese women treated for breast cancer were compared with a randomly selected group of 34 female patients suffering from different kinds of malignancies. A structured interview was used to study both groups. The breast cancer group were found to be less depressed and more emotionally stable than those suffering from other malignancies, suggesting that the diagnosis of malignancy was the more important factor in the psychosocial morbidity of these patients.

Tuberculosis of the breast.

Sixteen cases of tuberculosis of the breast are presented. The clinical features were a firm mass or a recurring abscess of the breast, sometimes associated with discharging sinuses. Diagnosis relied on histological appearance, acid-fast bacilli being present in only 3 specimens and positive cultures obtained in 4 patients. Local excision of the mass and chemotherapy proved effective treatment.

Carcinoma of the thyroid.

Total thyroidectomy with excision of any enlarged cervical lymph nodes was the usual operation practised for carcinoma of the thyroid in this series. Extended thyroidectomy afforded cures in some patients with locally advanced disease. Preoperative drill biopsy of the goitre was a useful procedure. Other noteworthy features were the increasing occurrence of papillary carcinoma and the comparatively high incidence of malignancy in solitary nodules.

Pregnancy-related gigantomastia. Case report.

The term gigantomastia has been used to describe breast enlargement to extreme size, with sloughing, haemorrhage and infection. The condition is rare and a case of pregnancy-related gigantomastia is reported.

Wound implantation--A surgical hazard.

A review of the literature on wound implantation together with a report on an unusual case of implantation of squamous carcinoma at the site of a gastrostomy is presented.

A review of nipple discharge in Chinese women.

Nipple discharge was the presenting complaint in 104 patients (1.5%) from a series of 7000 women who were seen in a breast clinic over a 13-year period. Complete follow-up information was available in 66 Chinese patients. The mean age at presentation was 47 years. Twenty-six patients (39%) were postmenopausal. Unilateral discharge (92%) from a single duct (77%) was the main finding. There were five patients (8%) with proven breast cancer; benign duct papilloma was found in 17 patients. Multivariate analysis showed that cancer was most likely in women over the age of 55 (P < 0.05) and when the discharge was bloody (P < 0.05). Ductography was also found to be useful in the diagnosis of duct papilloma (P < 0.02).

Paraffinomas of the breast: an oriental curiosity.

BACKGROUND: The injection of liquid paraffin wax was a form of breast augmentation practised in Hong Kong 30-40 years ago. Patients may present many years later with complications of this treatment. METHODS: The records of 43 patients diagnosed with paraffinomas of the breast at a teaching hospital in Hong Kong were reviewed. These patients had received paraffin injections 3-41 years (median 17) previously. RESULTS: Patients presented with hard masses in the breast 4-18 cm (median 17) diameter. Ulceration or infection occurred in 10 patients. Mammography revealed a honeycomb appearance in the affected breast. Treatment included biopsy only (7), excision of masses (3) and total mastectomy (30, bilateral in 27). Histology demonstrated hyalinized and densely sclerotic fibrous tissue with cystic spaces of various sizes. CONCLUSIONS: Awareness of this condition facilitates the differentiation from tuberculosis and carcinoma of the breast which often present late in this population of patients. Adequate treatment usually require total mastectomy.

Oestradiol binding activity in rat liver tumours and in human hepatocellular carcinoma.

Oestradiol binding activity was studied in normal liver tissues of rats as well as in experimentally induced liver tumours by incubating a cytosol prepared from the tissue with radioactive oestradiol. The free radioactive hormone was absorbed by a dextran-charcoal suspension, and the amount required to saturate the receptors was calculated by a Scatchard plot. Similar activity was observed in normal human liver as well as naturally occurring hepatocellular carcinoma.

The complementary role of fine needle aspiration cytology and Tru-cut needle biopsy in the management of breast masses.

Fine needle aspiration cytology (FNA) and Tru-cut needle biopsy (TNB) have been used for the pre-operative diagnosis of cancer in breast masses as alternatives to open breast biopsy. The accuracy of clinical examination, fine needle aspiration biopsy and Tru-cut needle biopsy was assessed in 230 patients with palpable breast masses and the value of using both biopsy methods in the management was prospectively evaluated. Clinical diagnosis had a sensitivity of 89.2% and specificity of 78.4% (32.7% false positive, 6.5% false negative). Aspiration cytology was diagnostic in 78.4% of cancers and 71.6% of benign lesions [excluding non-diagnostic samples (27.4%), sensitivity was 96.6% and specificity was 100%]. Tru-cut needle biopsy identified 82.9% of cancers and 61.7% of benign lesions [excluding non-diagnostic samples (33.3%), sensitivity was 96.7% and specificity was 100%]. There were no false positive errors with either aspiration cytology or needle biopsy. Statistical comparison showed that there was no significant difference between aspiration cytology and needle biopsy. The combined result of both biopsies was superior to clinical examination when non-diagnostic samples were excluded. With the routine use of both biopsy techniques, frozen section was avoided in 73% of all cancers and unnecessary operations were avoided in 33.5% of patients which included breast cysts, benign mammary dysplasia and inflammatory lesions.